The lacrimal system is a very important component of the ocular anatomy. We generally do not know much about the lacrimal system but it has an indispensible role in keeping our eyes healthy. Lacrimal system manufactures tears which are required to flush out any foreign objects that may enter our eyes. Also, since the conjunctiva is exposed to the atmosphere it can get dried up if the lacrimal system does not lubricate it. The tears are produced by the lacrimal glands. The lacrimal duct supplies these tears to the surface of the eyes. Barring a few cases, all obstructions in the lacrimal duct are removed by surgery of the lacrimal duct.
The lacrimal system may suffer from multiple issues. In some cases, the tear duct gets blocked which causes the tears to come out of the eyes. This malfunction of the lacrimal system causes excessive watering of the eyes. Sometimes, because of the blockage of the tear duct, the tears also get infected. The only treatment for severe duct obstruction is surgery. Obstruction in the lacrimal duct may also cause the eyes to dry out and become very itchy. This happens because due to obstruction in the duct not enough tears are produced for the purpose of lubrication. Complete obstruction in the lacrimal duct and completely blocked tear ducts could be a congenital issue in children. However, this obstruction generally gets fine with time. In some cases, obstruction in the lacrimal duct could be because of a tumor. In that case surgery becomes mandatory.
Lacrimal system is a part of the ocular anatomy; therefore lacrimal surgery is a subspecialty of ophthalmology just like oculoplastic surgery. Oculoplastic surgery and lacrimal surgery are required in some very special cases where treatment by an isolated ophthalmic procedure cannot yield any result. Lacrimal duct surgery is also known as DCR. With lacrimal surgery the obstruction of the tear duct is cleared which is done by creating a drain outlet between the tear duct and the nose. After six months of the lacrimal surgery, the tube which is used to stent the tear duct is removed. This scars from this surgery almost become invisible after six months.
Types of DCR performed for rectifying problems of the lacrimal apparatus?
- External DCR: – External DCR is performed in case the patient has significant Epiphora, Dacryolith in lacrimal sac, Dacryocystitis and chronic conjunctivitis. The preoperative evaluation of the patient before the External DCR includes functioning of lacrimal pump and properly present and functional canaliculi and puncta. The patient is given topical anesthesia and then the lacrimal system is irrigated. Complete or near complete obstruction is indicated by forceful stream out of the other punctum. To reduce the bleeding, proper nasal packing is done before the External DCR. If the duct is partially obstructed the patient will be able to taste the irrigation fluid. If the lacrimal duct is 70%-90% obstructed, then this procedure is performed.
External DCR is the more popular type of surgery for the treatment of duct obstruction for aforementioned indications. Also, the success rate is higher in external DCR surgery. Surgery by this method facilitates visualizing the abnormalities in a better manner. The only disadvantage of surgery by external DCR is that a scar remains after the treatment.
- Endoscopic DCR: -The endonasal approach for lacrimal surgery involves the use of a video- endoscope. The results are quite similar to an External DCR. This procedure is performed by dilating the upper and lower orbital canaliculi and then inserting a video endoscope into it. The use of a light probe helps in identifying the lacrimal sac by illuminating it. To expose the sac, the bone wall may be drilled. Once the sac is opened, a tube is inserted into the nasal cavity. This tube is left in till it forma a fistula and provides a drainage for the tears.
- Canalicular DCR: – Canalicular blockage is a very common cause of acute watering of the eyes which is known as Epiphora. In Canalicular DCR, commonly silicone tubes are used for repairing canalicular obstruction. Silicone tubes are also used in repair of canalicular injuries and canalicular stenosis. A Canalicular DCR involves microsurgical dissection and silicone intubation to remove blockage in the canalicular system.
- Laser DCR: – Laser DCR or laser-assisted DCR is a transnasal approach which means it does not involve any external incision. The type of laser used in Laser DCR can either be Ho: YAG laser or a Potassium Titanyl Phosphate 532 diode. A CO2 laser is generally not used because it has several drawbacks like poor bone ablation and a complicated delivery system. Ho: YAG laser fibers can be used several times hence the cost of a single procedure becomes low. The KTP/532 diode laser leads to higher cost per procedure but has superior bone ablation properties. The difference between normal Endoscopic DCR and Laser DCR is that laser is used to cut through the mucosa and create a passage for the obstruction. The major advantages of Laser DCR is that it has lower hemorrhage rates and the operative time is also lesser.
Lacrimal duct surgery in India:-
Treatment of lacrimal duct by surgery is one of the most common procedures done in India. The surgery of lacrimal duct and the follow up treatment are quite simple. But timely treatment of any lacrimal duct obstruction is completely crucial otherwise the lacrimal duct may eventually require major surgery. In India, lacrimal surgery is a growing super specialty just like oculoplastic surgery. People often interchange the terms oculoplastic surgery and lacrimal surgery as both are sub- specialties of the same specialty. However, the aims of lacrimal surgery and oculoplastic surgery are completely different. Lacrimal surgery focuses on the problems of lacrimal duct and causes of obstruction in the lacrimal duct. Oculoplastic surgery focuses on the aesthetic and functional restoration of the ocular area. Whenever you have a problem in the lacrimal duct, the best choice of treatment would be a minor surgery at the top hospital in India. Dr. Shome who is the best oculoplastic surgeon of India practices at his chain of top cosmetic clinics in Mumbai. According to Dr. Shome, who himself is the top oculoplastic and facial plastic surgeon; there is not lack of best treatment facilities in the best hospitals of India. Infact in Mumbai, all the best hospitals have the top treatment facilities however most people come for treatment of lacrimal obstruction after a delay. That is the top reason of problems in India. People do not take the treatment seriously in India and he sees patients coming to him in Mumbai when the obstruction has become complicated. His best advice to the patients is to come for treatment as soon as possible.
Dr. Shome is one of top renowned surgeons in India and heads a chain of cosmetic clinics in Mumbai. Mumbai is the center of his practice and he treats patients from all over India for various ailments who come to him in Mumbai. The facilities at his Mumbai clinics ensure that each and every patient that comes to Mumbai gets the best treatment. Oculoplastic surgery and lacrimal surgery are growing super specialties and now many hospitals are getting ready for the same by enhancing their infrastructure. As an oculoplastic surgeon, he visits various hospitals in Mumbai for treating complicated surgery cases. He is invited not only in Mumbai but all over India for sharing his valuable insights on oculoplastic surgery. His various fellowships and experience make him the best in Mumbai and doctors all over India are eager to share his knowledge. As a consultant to some of the top hospitals in Mumbai, Dr. Shome is experienced in some of the most complicated cases that come to these hospitals form all over India. So, if you are suffering from an oculoplastic issue or a lacrimal obstruction, come to Dr. Shome in Mumbai. His experience as a super specialist oculoplastic surgeon makes him the best in not only Mumbai but the rest of India as well.